counselling skills competence framework research methodology · and pilling (2008) methodology,...

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Counselling skills competence framework

Research methodology

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Index

Executive summary 4

Aims and purpose 4

Introduction 4

Roles and responsibilities 5

Counselling skills definition 6

Development process 6

Initial scope and rapid review 7

Systematic Review 9

Prisma flow diagram 10

Summary and conclusions of the Systematic Review 11

Constructivist Grounded Theory Study 13

Comparison and integration of Systematic Review 15 and Grounded Theory codes and emerging themes

Expert Reference Group analysis and review of 16 emerging themes External expert review 16

Final ERG 18

Peer review process and analysis 19

Sign off for final framework 19

Appendices

Appendix 1 - Core group 21

Appendix 2 – Expert Reference Group (ERG) 22

Appendix 3 – Core group and ERG role in 23 facilitating data saturation

Appendix 4 – Grounded Theory – Initial purposive sample 27

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Appendix 5 – Analysis of codes from SR and GT studies; 58 initial and focused References 64 Glossary 76

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Executive Summary

BACP, the British Association of Counselling and Psychotherapy, is the leading professional body for the counselling professions in the UK.

Counselling skills rest loosely within our Ethical Framework for the Counselling Professions (EFfCP) (BACP, 2018), with no clarity of role, remit or responsibility.

This project used a mixed methods’ approach of; rapid review, Systematic Review and Grounded Theory; to develop an evidence-based competence framework for counselling skills.

The mixed methods’ approach adopted highlights the importance of weaving together professionalism, skills, knowledge and experience to create a collaborative, representative and applicable competence framework for counselling skills.

Aim and purpose of the report

This report begins by describing the preliminary investigative work of an initial scope and rapid review; followed by three key research stages undertaken in the development of the counselling skills competence framework:

1) Systematic Scoping Review (SR) 2) Constructivist Grounded Theory (GT) 3) Data synthesis

The aim is to provide a comprehensive account of how the research literature was gathered and reviewed in stages one and two, before being synthesised in stage three to provide a robust evidence base for the competence framework development. A glossary of terms and references are also included.

Introduction The Professional Standards strategy is aligned to our strategic intents and is a critical vehicle for making our commitment to a differentiated scope of practice and raising standards a reality across the counselling professions. Counselling skills are used by a wide range of professionals in both paid and voluntary roles but there are no common standards or competences. The development of this framework will offer a set of competences relevant to a huge and diverse workforce. This project understands a competence framework as something that broadly defines the knowledge and skills needed to be effective within a role or sector. The framework consists of a number of competences, which can be generically applied to a broad number of contexts. Each of these competences is then defined and broken down into manageable components, using language that is clear enough to ensure that everyone has a common understanding of what the effective

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use of counselling skills means. This common understanding then becomes the benchmark against which the performance of an individual can be assessed; both in the workplace and also in education and training.

Roles and responsibilities

The project is held within BACP’s Professional Standards department, and overall

responsibility lies with the Chief Professional Standards Officer (CPSO).

A Professional Standards Development Facilitator (PSDF) oversaw the day-to-day

management of the project.

The groups involved in the development of the counselling skills competence

framework were the:

• core group

• Expert Reference Group (ERG)

• peer review group

Counselling skills core group

The core group comprised members of our staff and external experts who were engaged specifically to develop this competence framework. Membership and further information about the core group is listed in Appendix 1.

The core group was responsible for the quality and consistency of the research

methods, development of the framework and quality assurance of the outcomes.

Its first task was to define the initial scope for the research. This scoping

definition set the parameters of the research to be conducted by the Information

Analyst, who in turn produced an initial scoping report for discussion at the ERG.

The initial scoping report highlighted the potential limitations of conducting a

Systematic Review for this project and led to the core group and ERG agreeing to

incorporate GT to ensure authority and validity of outcomes.

The core group was also responsible for making recommendations, ratifying members of the ERG and facilitating its formation, and for ensuring maintenance of all relevant lines of communication.

Counselling skills expert reference group (ERG)

External experts were recruited from an advert placed on the BACP website

inviting interest. The core group and the PSDF also made recommendations.

Membership and further information about the ERG is listed in Appendix 2. The

ERG members were selected based on their knowledge, skills and experience in

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counselling skills, for the specific purpose of developing this competence

framework.

ERG members made recommendations for refining the parameters of the literature

search, assisted in filtering relevant competences for inclusion in or exclusion from

the framework, identified gaps and made suggestions to address them, and

ultimately developed the draft counselling skills competence framework.

Counselling skills definition

The core group and ERG were tasked with arriving at a definition for counselling

skills, to help define the task of identifying competences for these skills. This task

highlighted the complexity of the subject and the many-faceted phenomena known

as counselling skills proved very difficult to capture in a definition.

The core group and ERG considered a number of definitions from the literature and

also considered who might use counselling skills, with whom, as well as what

distinguishes them from counselling. An iterative process formed the definition

since the final definition was not arrived at until the literature search had been

completed, so this could also inform the definition.

The definition agreed by the core group and ERG for this project is:

Counselling skills are a combination of values, ethics, knowledge and communication skills that are used to support another person’s emotional health and wellbeing. They are not exclusive to counsellors since a wide range of people use them, often to enhance a primary role. Their use is therefore dependent on who is using them and the setting in which they’re used.

Development process

The process of our competence development has historically aligned with the Roth and Pilling (2008) Methodology, whereby the competence framework is developed through a Systematic Review of the available research literature, by an Information Analyst with the necessary skills to undertake a Systematic Review effectively and to appropriate standards of methodological rigour. In applying this methodology to the development of the counselling skills competence framework, it became evident that the approach was not broad enough to capture all relevant literature and that the Systematic Review carried intrinsic limitations. Definitional and logistical challenges made adequate study of the topic through Systematic Review very difficult, leading to the necessity to include a further research method to supplement the findings with additional evidence.

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A new paradigm will not arise from systematic reviews of research literature (Salmon and Young, 2017, p.259).

A Constructivist Grounded Theory study (GT) was introduced to allow a more interpretive and critical review of relevant literature. This method is not limited by exclusion criteria or narrow search margins. It allows the contribution of selected items of literature rather than a further comprehensive search and synthesis. GT allowed the use of inductive reasoning to generate interpretative theory; and the primacy of subjectivity over objectivity as a valid source of content. (Strauss and Corbin, 1988, P136-137)

The project’s core group, in collaboration with the Expert Reference Group (ERG) considered that a mixed methods’ approach would add quality to the research and take the data to a deeper level. It was also agreed that the GT method could be utilised to develop key counselling skills competences that emerged from the Systematic Reviews’ data, therefore grounded in the data. One of the benefits of GT is that it allows the use of other data sources (documents, diary notes, observations). We agreed to add the observations of external experts who would be asked to take a critical approach to the final competences that developed through the GT analytic steps. Scrutiny and criticality are associated with trustworthiness of research. Lincoln and Guba wrote extensively about trustworthiness and that the aim of trustworthiness in a qualitative inquiry is to support the argument that the inquiry’s findings are ‘worth paying attention to’. (Lincoln and Guba, 1985)

The final analytic step was to incorporate the opinions of peer reviewers to arrive at the final competence framework for counselling skills. The peer reviewers were recruited based on knowledge and experience in the field of counselling skills and covered a broad spectrum of roles and settings affiliated with these skills. They were asked five questions based on the content, structure and language of the draft framework. Their responses were summarised and presented to the core group and ERG who made decisions on how to use the information to improve and complete the competence framework.

Initial scope and rapid review

Rationale ‘Counselling skills’ is quite a broad term used by many professionals in different contexts, used widely with no clear remit about the role or responsibilities of the professionals. The role of counselling skills within counselling is also not clearly defined and developing a framework for counselling skills across such a diverse population led to this rapid review. It was also due to the large number of sources related to the subject. The aim of this review was to rapidly map the key concepts that underpin the subject area of counselling skills. Another of the main reasons for the rapid review was the complexity of the subject area. Firstly, the use of counselling skills is often embedded within a professional role, and this makes it

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extremely difficult to extract the exact specific skills without including the context or the quality of the personnel involved in using the skills.

Process The learning outcomes and assessment criteria from existing counselling skills’ qualifications and courses, alongside relevant health and social care competences were identified and then grouped into topics to provide a starting point of content to compare later research findings with, and to provide the core group and ERG with initial discussion points. This was a useful exercise to establish the training standards currently in operation and reduce any potential bias of the ERG and our teams being the only contributors. This therefore contributed to the project by providing an initial objective research base and reducing risk of expert subjectivity bias. The rapid review offered the ERG an overview of the learning outcomes and assessment criteria of ALL currently available, nationally recognised qualifications in the UK, to enable comparison with data and literature in the research field. Competences from social care, related to counselling skills were also considered to provide an initial conversation for what roles and settings were or who could benefit from counselling skills. The emerging themes from the rapid review’s manual literature search were:

• professional ethical guidelines

• professional relationships

• listening, responding and relational skills

• counselling skills in a primary role

• emotions, empathy and acceptance

• difference and diversity

• professional support and guidance

• self-awareness and self-care

• care pathways and referral

• assessment, care planning and review

• risk assessment

• personalised care and support

• working with a range of difficulties and disabilities

• using a variety of media: writing, digital technology etc

• communicating with friends and family of the person you are working with

• using skills in groups and meetings, and with colleagues and other agencies

• communicating in writing

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Systematic Scoping Review

The rationale for the Systematic Review (SR) was to identify published literature on counselling skills to provide an evidence base for the development of a competence framework.

The PSDF offered the core group a pre-scoping document. The scoping document suggested types of documents for inclusion including primary sources such as systematic reviews and secondary sources such as books, looking at publication dates from 2000, published in English and from around the world. Initial search terms were suggested and along with wider search terms for subsequent use as well as exclusions. This set the initial parameters for the counselling skills’ literature search and provided the Information Analyst (IA) with the scope of the initial search. The pre-scoping document reduced the likelihood of random error from too much information and provided a basis for the external literature review. The aim was also to reduce bias by having a clear protocol for the competence framework development.

Databases The main databases used were PsycInfo, Embase, Medline, and CINHAL. A small search through OVID database was carried out to include searches from social policy and practice database, as it covers social work and social care related literature. Substantial resources were provided by RUL’s Tate Library, which subscribes to the database Psychology and Behavioural Sciences Collection, and PsycARTICLES/PsycINFO/Extra/Books/Therapy provided by the American Psychological Association. This source also included:

• Sage Premier e-journals,

• Science Direct neuroscience and psychology collections,

• Taylor and Francis Social Sciences and Humanities e-journal collection,

• RULDiscovery – discovery system where you can search the whole of the collection including all e-resources subscribed to by the library.

Some terms were searched across four data bases and others through RUL and BACP (EBSCO) database. The searches were completed by the end of October 2018. The PRISMA diagram shown at Figure 1 shows numbers of documents identified and excluded at each stage of the process.

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Figure 1 - PRISMA 2009 Flow Diagram

Records identified through databases (n = 2826)

Scre

en

ing

Incl

ud

ed

El

igib

ility

Id

en

tifi

cati

on

Records after date and duplicate screen=1929

Records excluded (n = 1429)

Full-text articles assessed for eligibility

(n=140)

(n = 38)

Full-text articles excluded (n = 177)

Records abstract screen (n=871)

Records excluded (n=860)

Full-text articles included (n =23)

N= included in the review (n=23)

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Upon completion of the searches and analysis of the relevant documents, a full report of the findings was produced by the IA and presented to the ERG. The report explains the scope of the project and qualifies the study selection. It goes on to offer an initial analysis of the data and the intrinsic limitations of the outcomes. Feedback from the ERG is included in all areas.

Summary and conclusions of Systematic Review

There was limited evidence on counselling skills, which is not surprising given the evidence. In a meta-analysis on specific methods used in counselling and psychotherapy skills training carried out by Hill and Lent (2006), all available studies from 1967-2006 were examined. It was concluded that of all the studies only 14 were suitably designed to yield an effective size, revealing an unsettling scarcity of findings given the 40-year span. This was similar to our experience of conducting this review. Systematic Reviews were initially used in the field of natural sciences where the predominant methodologies were quantitative and easily measurable. This posed a huge challenge for this project when screening and assessing the data, as the few studies that were available were qualitative and some had no clear methodology. The limitations identified during the Systematic Review were manifold and threatened the value and validity of the findings. Lack of strong research in this area This finding was borne out by the facilitation of the Systematic Review.

The authors critique the literature and suggest that the studies in the helping skills literature generally fail to meet contemporary methodological standards, thereby limiting the conclusions that can be drawn (Hill and Lent, 2006).

Amount and quality of data: The amount of data, 2826 papers, generated during the Systematic Review were overwhelming to the point of being unmanageable but there remained a lack of meaningful data. Many studies identified within the search, when read, were not relevant or useful to the project because the focus of the paper was on skills within practitioner training or in the primary role and lacked focus on the use of counselling skills. Inconsistent or interchangeable use and meaning of the terms associated with counselling skills: Terms are used differently across authors and articles, creating confusion. Terminology and the unmanageability of the same term being applied to different things challenged the validity of the outcomes.

Authors tended to assume readers knew what was meant by empathy, but reviews of the literature suggest that empathy can mean many different things (Duan and Hill, 1996). These definitional problems often make it difficult to ascertain whether researchers were truly targeting the same skills despite using the same labels.

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Excluded studies: The ERG had decided to exclude any studies where qualified counsellors or psychotherapists used counselling skills in their work. There were two reasons for this decision. The aim of this review was to identify those who used counselling skills as part of their core professional roles i.e. where the use of counselling skills was secondary to their main professional role and that it complimented or enhanced their primary professional role. Secondly the trained counsellors or psychological therapists would understand the process of therapy and their use of skills would be very much influenced by their knowledge and expertise in the area of counselling or psychotherapy. This decision proved to place severe limitations on the data and excluding these data removed the majority of training literature from the review. The limitations of the SR enabled a further research method to be deployed, which gave the emerging themes and end product greater authority and meaning.

Defining the next steps

Discussion among the core group regarding the limitations of the Systematic Review, led to the agreement to progress the review to another level by adding Constructivist Grounded Theory (GT) principles and procedures to the analysis of the sources identified with the aim of adding quality and depth. During the Systematic Review, papers were suggested by ERG members, that whilst very relevant, sat outside the tight search criteria and were therefore excluded. These additional papers were identified by the ERG as the Systematic Review ‘plus’. Including these papers allowed a broader view with a clearer focus. Inter-rater-reliability allowed the consideration of papers that sat outside the search criteria if they were of clear benefit to the project. These papers were brought into the review and a GT approach was introduced to the analytic steps to allow a more interpretive and critical review and analysis of the relevant literature. The core group and ERG agreed that GT would provide the necessary analytic steps, reduce the data and enhance the quality of the competence framework for counselling skills.

Waifs During this process, it was noted in ERG during discussions that symbolically, counselling skills seemed to have some similarities to ‘waifs’. Waifs are homeless and generally neglected and unwanted children. The phenomena we know as counselling skills is oftentimes without a home and seen as of less value, and afforded less care and attention than its more salubrious cousins, counselling and psychotherapy. Therefore, counselling skills can be viewed metaphorically as waifs. The counselling skills’ waif needs a home or host in order to exist and have substance and meaning. Counselling skills’ waifs can have many homes: nursing, caring, teaching, psychology, care and support. The Systematic Review tended to

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search the homes (hosts) looking for the counselling skills (waifs); but the waif or counselling skill was often hidden by the home (host). If we adopt the old saying; ‘Can’t see the woods for the trees’:

• In the Systematic Review, we couldn’t see the waif for the home (host).

• In the current paradigm we can’t see the counselling skills for the role and

setting.

We learnt we needed to look at waifs reflexively to learn their personality,

strengths and weaknesses in order to then be able to understand their relationship

with their home (host) and thereby provide safe, coherent and effective use of

counselling skills in a range of roles and professions. We needed to research waifs

looking for homes (hosts) and GT helped us to complete that task.

Constructivist Grounded Theory

This study shows how the application of the constant comparative analysis procedure in various stages, assured in-depth analysis of the data that emerged from the Systematic Review and the Systematic Review Plus, and enabled the production of an advanced concept matrix of counselling skills organised under key categories.

Method Creswell (1988) identified the following steps, which informed the execution of this study:

• a process approach

• theoretical sampling

• constant comparative method

• memoranda

• series of coding and recoding data

• theory generation Following the completion of the SR, the GT study began. A sample of relevant literature was chosen purposively. This initial sample was chosen by members of the ERG and external experts (Appendix 7). This initial purposive sample consisted of 14 studies. The samples sat outside of the inclusion criteria of the Systematic Review and were titled ‘Systematic Review Plus’. Due to the purposive nature of the sample, deductive interpretation can be used to arrive at sufficient evidence to furnish a competence framework that is both pragmatic and appropriate for a range of professional roles and settings. In line with GT, project-based memos were used to provide commentary at each stage of the process. They were used to ask the ERG questions and to offer topics for discussion and reflection. Any emerging themes, ideas, contradictions etc. were also noted and discussed.

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Data analysis The first step was to identify and code the GT initial data sample. This is particularly important in GT as it helps clarify what is happening and what it means in relation to this project and a competence framework for counselling skills. The initial coding generated as many ideas as possible to be able to identify the important, prevalent codes. The initial codes formed the basis for further data collection and analysis to arrive at a set of provisionally emerging themes. For the GT study, analysis and initial coding were executed by the PSDF, overseeing the project, who stepped into a research role to help the project groups address the serious limitations in the Systematic Review. For the SR, analysis and initial coding was executed by the IA. Codes were assigned to try to incorporate the range of terms used across the literature and across the professions as a whole. The analysis of the initial codes that emerged from the GT study, were subject to more focused coding, and topics and theories began to emerge. All outcomes were discussed at core group and ERG meetings and revisited throughout the stages of the study to ensure rigour and integrity.

GT report summary The themes emerging from the purposive sample were:

• benefits of counselling skills, helping skills • professionalism and ethics • therapeutic conditions • the relationship • listening and responding skills • diversity and empathy • models and stages of helping work • self-awareness • common factors • supervision

These themes correspond to many of the themes identified in the initial scope and

rapid review, (Appendix 5).

This goes some way to assuring the validity of the identified codes, emerging

themes and conclusive competence framework. The themes from the SR allowed

further consideration and integration and provided a third layer of authority and

quality assurance. Gaps were identified around supervision, ethics,

professionalism, listening, and diversity. In these areas, evidence was present but

weak and lacking the substance to be meaningful.

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The ‘project memos’ were useful for recording thoughts and identifying questions

for the ERG.

Comparison and integration of Systematic Review codes and Grounded Theory codes and emerging themes

The outcomes from the SR were compared and considered against the outcomes

from the GT study to arrive at a single set of emerging themes. Further

information on the analysis of codes from SR and GT studies; initial and focused

are detailed in Appendix 6. Themes were identified, which were then grouped into initial counselling skills competence areas. The purposive sampling, coding and analysis formed an iterative process which continued until the data were unable to offer anything new to the codes, themes and theories. The outcomes from the studies were compared and synthesised, and the competence framework for counselling skills was constructed from the evidence provided by the two studies (SR and GT). The initial scope and rapid review added an additional layer of quality and comparison for validity. Coding for both studies was challenging due to:

• the overlapping relationships between skills, settings and roles

• the plethora of terminology used to describe counselling skills Sometimes studies are not clear about what type of practitioners are using what type of skill and with which sort of client

The coding comparison of the two studies (SR and GT) and integration occurred in stages. The initial coding was discrete to each study and the initial codes emerging from the data from each study were collated into focused codes.

PSDF, IA and an academic from Regents University met formally to discuss the focused codes from each study, to see how they related to each other and the original data. The codes were kept as similar as possible to the original data in line with Charmaz’s (2006) method. Comparing the different codes and data enabled seven theories or themes to emerge as:

• counselling skills

• therapeutic relationship

• professional qualities

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• professional values

• role responsiveness

• role specific

• empowering

These themes were expressed in this set of seven concepts that related to one another in a cohesive way, encompassing the skills, values and qualities required to use counselling skills helpfully and safely within a primary professional role. These themes set the foundations for the constant comparative analysis procedure associated with GT. This enabled ongoing analysis to ensure that the outcomes were valid and relevant. The initial seven emerging themes were tabulated and populated with the codes identified from the two studies (SR and GT).

Expert Reference Group analysis and review of emerging themes

The emergent themes were considered by the ERG in preparation for external review. Inter-rater-reliability allowed amendments to be made in line with GT process. Inter-rater-reliability, in this instance, measures the degree of agreement between different people (Expert Reference Group) observing or assessing the same thing. In this case, subject experts met and shared knowledge and experience, in order to agree on how to categorise different skills and values related to the competence framework. The review was consistent with the constant comparative style related to GT. The members of the ERG discussed and compared thoughts and opinions arising from the data, the coding activities and the resultant themes, theories and emerging competences.

Outcomes The decisions made by the ERG were implemented, which resulted in a second iteration of the headings and emerging competences. The seven themes were reduced to five by removing ‘Empowerment’ and ‘Role Specific’.

External expert review

Following the review of the emerging themes by the ERG, the process, content and outcomes thus far were sent for review by five external experts with extensive knowledge and experience of the role and meaning of counselling skills.

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Throughout this project, there was movement back and forth between different narratives and analysis. This stage of analysis was to ensure all voices relevant to this project had the opportunity to be heard and understood. It allowed a wide range of knowledge and experience to inform the counselling skills framework. The external experts were invited to comment on the competences that emerged following the analytic stages of GT to add a further dimension of quality to the process. The experts were given an overview of the analytic process and on the theory and themes that emerged inductively from the data and to comment on the following:

1. the outcomes and emerging theory 2. subcategories 3. researcher findings 4. are any of the findings not as expected? 5. are there any missing elements or gaps?

By adding this inter-rater-reliability testing, quality and outcome reliability was strengthened, and the process ensured that the data were represented throughout. The feedback received from the experts was discussed by the core group and comments noted. The research team met to scrutinise this analytic step and compared the feedback received from the external experts and the core group to make decisions, true to the data and emerging themes.

Outcomes Inter-rater-reliability was acknowledged but not deemed more important than the data and the analytic steps already undertaken. Through discussion and analysis, ‘Empathy’ became the 6th theme. The data were prolific as was expert feedback. The three subheadings were:

• Understanding through empathy

• Naming and attending to emotion

• Collaborative communication.

The theme, ‘Professional values’, was reinstated and ‘Working in context’, removed. The group felt it was important to hold the value of counselling skills in esteem, in line with the data. The suggestion to remove the word ‘professional’ was challenged as it suggests that counselling skills’ users are not professionals. The importance of removing historic and current hierarchies of value was highlighted. The possible unconscious bias of the ERG was noted in removing ‘professional’ from the original themes. The themes identified were:

• empathy

• role responsiveness

• helping

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• professional values

• consultative support

• sensitivity to culture

The next step of the process was for the ERG to give the framework final scrutiny and sign off the framework as ready for peer review. An additional layer of scrutiny and feedback from a critical friend to the project and expert in the field of counselling skills were included post the external expert review period, to ensure data saturation was comprehensive and complete. This feedback was discussed at core group and ERG meetings, and outcomes were recorded and implemented.

Final ERG

Once all the expert feedback had been analysed and implemented, the final ERG met to sign off a draft competence framework for counselling skills as ready for peer review and offered the following amendments to be made prior to the peer review process. All outstanding queries and feedback were discussed and synthesised appropriately into the draft framework with the consensus of the group and research team. During the meeting, the following issues were discussed, and amendments agreed:

• to remove ‘attunement’

• ‘ability to make use of professional support and guidance’, added

• ‘working alliance’ agreed as the final term for ‘the relationship’

• ‘reparative relationship’, removed

• ability to draw on personal attitudes, values and qualities – changes made under personal qualities

• data protection and referral – changes made

• ability to demonstrate affect tolerance - simplified

Once all the changes had been agreed and implemented. The draft framework was ready for peer review.

Peer review process

Twelve peer reviewers applied who met the requirements of the role. Peer reviewers were representative of the roles, settings and sectors that could or do utilise and benefit from counselling skills:

• educators – teaching and learning – HE and FE Awarding organisations

• voluntary, statutory and charitable organisations

• health and social care settings

• organisations responsible for standards and quality

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Peer reviewers were:

• experts in the field of counselling skills

• knowledgeable around structure and content of competence frameworks

• aware of a wide range of professional roles that benefit or could benefit from using counselling skills

• experienced in working in the care sectors, health sectors, business, teaching and nursing professions

• up to date with any initiatives or innovations that relate to counselling skills

The reviewers were sent the draft framework and asked to comment on the following:

• the structure of the framework

• the content of the competence framework

• the title and content of each competence

• the language used in the competence framework

• any further comments, concerns or suggestions in relation to the competence framework and its content

Analysis of peer review

Out of the twelve peer reviewers:

• seven returned the review feedback

• two were ill

• three did not respond

Peer reviewer feedback was collated and discussed by the core group.

Agreed refinements were made. The feedback also includes the identified

benefits, which further strengthen the research base this project stands

firmly on.

Final sign off: completed Counselling Skills Competence Framework

Following the core group analysis of the peer feedback; the necessary and agreed

changes were made to the draft framework. Feedback was positive in the main.

Areas for development included acknowledging the tensions between the use of

counselling skills and the professional role and clarifying the roles within the

framework. The CPSO reviewed the feedback and process, and offered further

refinements and suggestions, whilst agreeing the majority of the changes.

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Once all the necessary amendments were made, the draft framework was sent to

the ERG for final sign off, which happened in October 2019.

The final BACP competence framework for counselling skills can be found our website.

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Appendix 1 – Core group

Members of the Counselling Skills’ Core Group

Internal members:

• BACP Chief Professional Standards Officer – Fiona Ballantine Dykes

• BACP Professional Standards Development Facilitator (Project Lead and

Chair) – Traci Postings

• BACP Research Department – Doctor Emma Broglia

• BACP Clerk to the ERG and core team – Eve Orton

External members:

• Information Analyst – Jessie Emilion

• Critical Friend – Professor John McLeod

• External Scrutiny of Research and Quality Assurance – Professor John Nuttall

and Doctor Maria Luca (Regent’s University)

The core group formed prior to the ERG and was instrumental in setting the terms

of reference for the ERG. The core group met strategically throughout the project.

Initially the group met monthly and this moved to bi-monthly midway. The core

group resumed meeting monthly when the research methodology had to widen to

ensure valid and useful data outcomes.

The core group met, and were quorate on the following dates:

26.6.18, 23.7.18, 23.8.18, 20.9.18, 22.11.18, 17.1.19, 21.2.19, 15.3.19, 3.4.19,

4.7.19.

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Appendix 2 – Expert Reference Group (ERG)

Members of the Counselling Skills’ Expert Reference Group (ERG)

Members from core group:

• BACP Chief Professional Standards Officer– Fiona Ballantine Dykes

• BACP Professional Standards Development Facilitator (Project Lead) – Traci

Postings

• BACP Clerk to the ERG and core team – Eve Orton

• Information Analyst – Jessie Emilion

• Critical Friend – John McLeod

External experts:

• CEO CPCAB – Anthony Crouch

• Newman University – Faisal Mahmood

• Dorset CC Commissioner of services – Diana Balsom

• Director of Services Cruse – Andy Langford

• Skills for Care – Victoria Collier

The ERG were scheduled to meet five times and all meetings were quorate and

took place on the agreed dates:

16.8.18, 13.9.18, 1.11.18, 24.1.19, 9.5.19.

Due to the additional level of enquiry and scrutiny in the GT study, an additional

ERG meeting was added to sign the draft framework off as ready for peer review.

This took place on:

12.7.19.

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Appendix 3 - Core group and ERG role in facilitating data saturation

The core group and ERG were both part of the constant comparative procedure of GT and the table below outlines how the

groups identified and implemented the steps to data saturation:

Date Group Search criteria

26.6.18 Core Initial search terms agreed in line with the pre-scoping document: “Counselling Skills” “Counselling Skills” “Helping Skills” “Embedded Counselling Skills” “Embedded Counselling Skills” “Embedded Helping Skills”

23.7.18 Core Reviewed the parameters of the literature search and agreed:

Adults only 18+

Timeline from 2000

Across settings

16.8.18

ERG After expert discussion it was agreed to search: “Lay Counselling” “Motivational Interviewing” “Helping Skills” – Clara Hill has done research in this area

It was agreed not to include: “Coaching and Befriending” “Mediation”

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“Qualified Counsellors Trainings” – too big an area, once counselling role is added it becomes unmanageable

23.8.18 Core “Listening Skills” which had produced over 949 articles with a large amount of duplication. After scanning there were 513 articles. 137 good articles to look at which will produce evidence to map. “Lay Skills (Lay Counselling)” this had produced 159 articles; many are about difficulties that are being experienced by those using counselling skills, i.e. know how to contain and hold without being overwhelmed

13.9.18 ERG Searches as suggested by the ERG and critical friend:

“John McLeod” “Clara Hill” “Helping Skills” “Listening Skills” “Psychosocial Support”

“Couple Counselling” excluded “Psychotherapy Trainees” excluded

20.9.18 Core Update from the Information Analyst (IA) who remarked on the size of the search and the screening task. In response the group decided to reduce the date search to 10 years

IA still to search:

“John McLeod”

25

“Clara Hill”

Decision made not to search for:

“Written Communication”

Any literature where counselling skills were used via

“Telephone, texts or online”

1.11.18 ERG Critical friend JMc stressed importance of searching:

“Clinical skills”

“Interpersonal skills”

22.11.18 Core Focus of group was on the methodology and the need to incorporate additional literature for meaningful and relevant outcomes

PSDF delivered an additional research project using a Constructivist Grounded Theory approach. The outcomes to be synthesised with the outcomes from the Systematic Review to provide a fuller picture of the landscape for counselling skills. This was agreed

7.1.19 Research

team

IA and PSDF met to compare and synthesise the codes from each study into themes. ML was present to add authority and objectivity to the activity

26

17.1.19 Core group Discussed initial emerging themes from the codes.

Identified and agreed next steps of research:

1. Group of experts to comment on the emerging themes and draft competences.

2. The final stage is peer review.

24.1.19 ERG Used emerging themes to offer feedback to prepare the draft framework for external review

21.2.19 Core The group confirmed the process order for completion

15.3.19 Core Expert reviewer feedback discussed, considered and implemented within framework where agreed

Peer reviewers selected and agreed

3.4.19 Core Questions for peer review agreed Further focus on external expert feedback

9.5.19 ERG Discussed issues identified by core group

Emerging themes and resultant competences subjected to further inter-rater-reliability

4.7.19 Core Preparing framework for ERG sign off and peer review

12.7.19 ERG Group discussed and disseminated final expert feedback and signed off the draft framework

27

Appendix 4: Grounded Theory – Initial Purposive Sample

Authors and date Country Population

(age range) Intervention (type of therapy)

Source Sample size

Findings and conclusions

1 Interpersonal Competencies: Responsiveness, Technique, and Training in Psychotherapy Robert L. Hatcher City University of New York 2015

Canada Psychology students

responsiveness

http://dx.doi.org/10.1037/a0039803

Professional practice in psychology is anchored in interpersonal, or relational skills. These skills are essential to successful interactions with clients and their families, students, and colleagues. Expertise in these skills is desired and expected for the practising psychologist. An important but little-studied aspect of interpersonal skills are what Stiles and colleagues (Stiles, Honos-Webb, and Surko, 1998; Stiles, 2009, 2013) have called appropriate responsiveness. In treatment relationships, appropriate responsiveness is the therapist’s ability to achieve optimal benefit for the client by adjusting responses to the current state of the client and the interaction. This article looks at the development of skills

28

Authors and date Country Population (age range)

Intervention (type of therapy)

Source Sample size


underlying appropriate responsiveness and the role of stable differences in talent in training of professional psychologists. As such it may be a meta-competence, with implications for the design. Use of these techniques is influenced by their always active judgment of how best to conduct the session with the particular client. This judgment involves what Stiles and colleagues (Stiles, 2009, 2013; Stiles et al., 1998) have called appropriate responsiveness. Each member of a dyad adjusts his or her responses to the other, each guided by his or her particular goals for the interaction. In the context of therapy, responsiveness is appropriate when it is effectively dedicated to the goal of helping the client. This means that the therapist exercises flexible and astute judgment in the conduct of the session,

29



Source Sample size


anchored in perception of the client’s emotional state, needs, and goals, and integrates techniques and other interpersonal skills in pursuit of optimal outcomes for the client. Appropriate responsiveness involves knowing what to do and when to do it. However, the thrust of these models is that competence is the sum of many discrete competences, whereas the substance of the current discussion is that the capacity to integrate and orchestrate the use of these discrete competences is a critical factor in its own right. Many important questions remain about the trainability of appropriate responsiveness. Limits in innate talent may constrain the effectiveness of training (Nissen-Lie and Orlinsky, 2014), as may the nature of the trainee’s formative interpersonal experiences prior to graduate training. The question of how to

30



Source Sample size


enhance appropriate responsiveness has barely been addressed by the field. Friedlander (2012, 2015) suggested that supervision is a critical venue for modelling appropriate responsiveness. In addition to the helping skills approach discussed above, other curricula have sought to bolster some of the capacities that contribute to appropriate responsiveness, such as sensitivity to one’s own and other’s emotions, affect tolerance, and perspective taking (e.g., Hen and Goroshit, 2011). Links to empathy and interpersonal skills

2 Helping Skills Training for Undergraduates: Outcomes and Prediction of Outcomes Clara E. Hill, Melissa Roffman, Jessica Stahl, Suzanne

US Undergraduates

Helping skills Journal of Counselling Psychology Copyright 2008 by the American Psychological Association

85 students

The authors examined outcomes and predictors of outcomes for 85 undergraduates in three helping skills classes. After training, trainees used more exploration skills in helping sessions with classmates (as assessed by perceptions of

31



Source Sample size


Friedman, Ann Hummel, and Chrisanthy Wallace

2008, Vol. 55, No. 3, 359–370 0022-0167/08/$12.00 DOI: 10.1037/0022-0167.55.3.359 Qualitative study

helpees and helpers or trainees as well as behavioural counts of skills), were perceived by helpees as more empathic, talked less in sessions, conducted better sessions (from helpee and helper and trainee perspectives) and reported higher self-efficacy for using helping skills. In addition, trainees’ confidence increased while learning exploration skills dropped while learning insight skills, and then increased again while learning action skills. The authors were not able to predict outcome from the variables used (grade-point average, empathic concern and perspective taking, perfectionism). Suggestions for training and future research on training are included. After training, undergraduate trainees were able to conduct better sessions while interacting in the moment with classmates sitting across from them talking about real concerns. In

32



Source Sample size


particular, trainees used more exploration skills in their second helping session with classmates than they did in the first. It is important to note that this finding was replicated across three different perspectives Students talked less in their second helping sessions than they had in their first sessions. Talking less reflects listening more and focusing more on the helpee and seems to be a major change that trainees make when they first begin to learn about helping. The shift in talk time can be difficult for beginning trainees who are used to talking and sharing the focus in friendship relationships, so talk time may reflect a shift to taking on a more professional role. Helping skills Communication skills, empathy, insight skills, action skills, explorative skills.

3 US Students Psychological helping

Sub-Department of Clinical Health

29 Psychotherapy interactions and social support conversations have

33



Source Sample size


Psychotherapy and social support Integrating research on psychological helping Chris Barker*, Nancy Pistrang

Psychology, University College London, Gower Street, London WC1E 6BT, UK Received 21 December 2000; received in revised form 9 March 2001; accepted 30 April 2001 Clinical Psychology Review 22 (2002) 361–379

many similarities, as well as some important differences. Researchers studying these two manifestations of psychological helping, often known as formal and informal helping, usually apply a separate set of concepts and methods to each and tend to locate their work in separate bodies of literature. This paper argues that such a division of the field is unnecessary and unproductive. It outlines several ways in which the two bodies of literature might inform each other and argues for conceptual integration of the two fields. We have argued that the two fields of psychotherapy and social support are presently unnecessarily disparate. Our central contention is that they can each learn from the other and that both would benefit from more integration and examination of common processes. The informal helping relationship allows ideas about fundamental and generic

34



Source Sample size


processes in helping to be tested and throws into sharper focus those factors that are unique to professional helping. One way in which the field might progress is for researchers to identify generic processes of psychological helping, such as establishing a helping relationship, making meaning, and promoting change, in a variety of helping contexts. The ultimate goal is to develop a theory of how human relationships can lead to positive psychological change. Draws on parallels between different therapeutic interactions. Helping skills and the helping relationship highlighted.

4 Counselling Skills Pre-Practicum Training at Guidance and Counselling Undergraduate Programs: A Qualitative Investigation. Mine ALADAĞa

Turkey Undergraduates

Counselling skills

Educational Sciences: Theory and Practice - 13(1) • Winter • 72-79 ©2013 Educational

11 students

This study was aimed to describe counselling skills pre-practicum training at guidance and counselling undergraduate programs in Turkey. A descriptive study was conducted based upon qualitative data. The

35



Source Sample size


Ege University

2013

Consultancy and Research Centre www.edam.com.tr/estp Qualitative study

research group of this study consisted of 11 guidance and counselling undergraduate programs voluntarily participate into study. The Survey Form developed by the researcher and consisted of 10 open-ended questions was used. A content analysis was carried out. The results showed that undergraduate programs mostly aimed to teach therapeutic conditions and reflection of content and feeling skills in the course; did not use a counselling skills training program as a base and mostly used instruction method to teach counselling skills; and implemented paper-pencil tests to assess counselling skills. Teaching basic counselling skills and developing professional identity and self-efficacy were mostly emphasized as important. For an effective counselling process, a skilful counsellor should have some professional skills. These professional skills include different types of skills

http://www.edam.com.tr/estp

http://www.edam.com.tr/estp

36



Source Sample size


such as relationship, helping, counselling, case conceptualization, diagnosis, strategies, and interventions (Cormier and Hackney, 2008; Hackney and Cormier). These skills are described as competencies ranging from the basic and simple level to the more advanced and complex, therefore more challenging level (Cormier and Nurius, 2003; Seligman, 2005; Sexton, 2000; Whiston and Coker, 2000) and examined in different ways. For instance, Winston and Coker operationalized these skills in the dimensions of (a) technical skills, (b) therapeutic approaches and interventions, (c) counsellor cognitive skill development. Counselling skills and techniques

5 Turkey Students Counselling

skills Educational Sciences: Theory and Practice • 14(2) • 879-886

67 students The aim of this study is to

contribute to the enhancement of the quality of counselling

37



Source Sample size


Opinions of Counsellor

Candidates Regarding

Counselling Skills Training

Mine Aladag, Baris Yaka and

Smet Koc

©2014 Educational Consultancy and Research Center www.edam.com.t

r/estp DOI: 10.12738/estp.2014.3.1958 Qualitative study

skills training and counsellor education through the medium of understanding the opinions of counsellor candidates regarding counselling skills training. The research group consisted of 67 counsellor candidates who voluntarily participated in the study. The research data was collected by three different qualitative data collection tools developed by the researchers. Content analysis was carried out and the results indicated five main themes: Counselling skills, specific skills training methods, perceptions of Counselling, being a counsellor candidate, the learning and teaching process of counselling skills. The results also showed that within the scope of systematic counselling skills training programs, using various skill training methods and instructional technologies which are integrated compatibly was effective. At the same time, the results indicated that counselling skills training

38



Source Sample size


provided an increase in professional competency and helped to develop the professional identity of counsellor candidates. The results are discussed and interpreted in light of the literature. It is considered that advanced counselling skills seemed complicated and frightening to counsellor candidates because they are not familiar with advanced counselling skills such as immediacy and confrontation. These skills are also not fitting to the roles with which they have been familiar, such as being a sympathetic friend (Ronnestad and Skovholt, 2003; Skovholt and Ronnestad, 2003). At this point, one should notice that this experienced challenge doubtlessly arises from the nature of advanced counselling skills. Thus, counselling skills are defined as a body of competencies classified hierarchically from simple to

39



Source Sample size


complex (Cormier and Nurius, 2003; Seligman, 2005; Whiston and Coker, 2000). Considering the counsellor candidates’ impressions, these challenges exist because advanced counselling skills are not taught with a systematic method such as MC. Thus, this issue is pointed out by almost all counsellor candidates. Individual counselling skills. Focus on trainee responses and challenges.

6 The Efficacy of Empathy Training: Emily Teding van Berkhout and John M. Malouff Online First Publication, July 20, 2015. http://dx.doi.org/10.1037/cou0000093

Australia Students Empathy Meta-Analysis of Randomized Controlled Trials. Journal of Counselling Psychology. Online publication. http://dx.doi.org/10.1037/cou0000093

18 RCT 1018 participants

High levels of empathy are associated with healthy relationships and prosocial behaviour; in health professionals, high levels of empathy are associated with better therapeutic outcomes. To determine whether empathy can be taught, researchers have evaluated empathy training programs. After excluding one outlier study that showed a very large effect with few participants, the meta-analysis

40



Source Sample size


included 18 randomized controlled trials of empathy training with a total of 1,018 participants. The findings suggest that empathy training programs are effective overall, with a medium effect (g _ 0.63), adjusted to 0.51. After trim-and-fill evaluation for estimated publication bias. Moderator analyses indicated that four factors were statistically significantly associated with higher effect sizes: (a) training health professionals and university students rather than other types of individuals, (b) compensating trainees for their participation, (c) using empathy measures that focus exclusively on assessing understanding the emotions of others, feeling those emotions, or commenting accurately on the emotions. The findings indicate that (a) empathy training tends to be effective and (b) experimental research is warranted on the impact of

41



Source Sample size


different types of trainees, training conditions, and types of assessment. This meta-analysis found that empathy training programs tend to be effective in increasing empathy levels. Empathy

7 Training Undergraduate Students to Use Challenges Harold Chui1, Clara E. Hill1, Stacie Ain1,Sara K. Ericson1, Heather V. Ganginis Del Pino1, Ann M. Hummel1, Erica S. Merson1, and Patricia T. Spangler1.

US Undergraduates

Challenge The Counselling Psychologist 2014, Vol. 42(6) 758– 777 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0011000014542599 tcp.sagepub.com

103 students qualitative

After they learned exploration skills, 103 undergraduate helping skills students were taught to use challenges. Prior to training, students’ self-efficacy for using challenges did not change, although the quality of written challenges and reflections of feelings did. After training, students rated themselves as having more self-efficacy for using challenges and were judged as providing better written challenges, although there were no further changes in quality of written reflections of feelings. Students maintained self-efficacy for using challenges at a five-week follow-up. Self-

42



Source Sample size


efficacy for using challenges increased after lecture, modelling, written practice, and lab group practice, but students indicated that practice was the most helpful training component. Natural helping ability predicted higher final levels of self-efficacy for using challenges. Qualitative results indicated that cultural background played a role in learning and using challenges. Challenges are typically taught in the Hill (2009) three-stage (exploration, insight, action) helping skills model as part of the insight stage; hence, students are first taught the exploration stage, whereby they listen empathically and encourage clients to delve into their thoughts and feelings. They use this time to build rapport and help clients feel comfortable exploring. After spending several weeks learning exploration skills, it can be quite daunting for students to

43



Source Sample size


shift focus and learn to challenge clients at the beginning of the insight stage. For example, Hill et al. (2008) found a drop in self-efficacy when students began learning insight skills. Students may worry about disrupting the therapeutic alliance or causing harm to clients due to the perceived confrontational nature of challenges. Trainees seem to have difficulty thinking about how to challenge clients in a manner that is gentle, supportive, and direct. Some focus on cultural impact of using skills of challenge.

8 Training Novice Psychotherapists: Helping skills and beyond. Clara E. Hill, Jessica Stahl, and Melissa Roffman

US Students Helping skills Psychotherapy: Theory, Research, Practice, Training Copyright 2007 by the American Psychological Association 2007, Vol. 44, No. 4, 364–370 0033-

Since the 1960s, helping skills training has been the dominant form of training for novice psychotherapists, especially in counselling psychology graduate programs but also increasingly in clinical psychology training programs. Most of the skills-based approaches that currently

44



Source Sample size


3204/07/$12.00 DOI: 10.1037/0033-3204.44.4.364

exist (e.g., Hill, 2004) are based on earlier approaches by Carkhuff (1969) and Ivey (1971) and involve teaching trainees skills such as open questions, reflections of feelings, and interpretations. Our goal in this article, then, is to present our ideas about how to do helping skills training. Within each section of this article, we provide hypotheses that synthesise our thinking about training. We note that we use the term helping skills in this article because this is a generic term that applies broadly to therapeutic interventions, and it is the term that is used in the training literature (e.g., Hill, 2004). Another term that is equally applicable and that has been used more frequently as applied to process research is “therapist verbal response modes” (see Elliott et al., 1987).

45



Source Sample size


Helping skills, values and qualities.

9 Training Undergraduate Students to Use Insight Skills: Integrating the Results of Three Studies. Clara E. Hill1, Patricia T. Spangler1, John Jackson1, and Harold Chui1

US Students Insight skills The Counselling Psychologist 1– 21 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0011000014542602 tcp.sagepub.com

Mixed methods

Comparison of a series of studies (Chui et al., Jackson et al., and Spangler et al.) investigating the effects of training undergraduate students in helping skills courses to use insight skills (immediacy, challenges, interpretation) after they had learned exploration skills. A comparison of students and instructors indicated similarity across the samples. Increases in self-efficacy for the target skill were found across all studies. In addition, all components (reading, lecture, video modelling, practice, and feedback) were found to be effective, but students found practice and lecture to be particularly effective in all three studies. Higher initial self-efficacy for the target skill and higher prior helping experiences were associated with higher final levels of self-efficacy; lower self-efficacy for the target skill and higher prior helping

46



Source Sample size


experiences were associated with greater gains in self-efficacy over the course of training in two studies. Limitations and implications across all three studies are discussed. Helping skills, self-awareness, insight skills, interpretation.

10 Examining basic helping skills in cross cultural counselling between European American counsellors and Mexican American clients. Collie Conoley, Melissa L. Morgan Consoli, Heidi Zetzer University of California Santa Barbara Elisa Hernandez Rafael Hernandez California State University San Marcos

Counselling Counselling skills

Revista Interamericana de Psicologia/Inter american Journal of Psychology (IJP) 2015, Vol., 49, No. 3, pp. 365-386 365 ARTICULOS

Mixed methods qualitative and quantitative

The need for culturally informed counselling skills addressed by using a multiple case study design that evaluates the basic helping skills with four volunteer Mexican American clients and four European American counsellors in the U.S. While viewing vignettes of each skill used in their counselling session, four clients responded to written measures and verbal interview questions immediately after each of their three sessions. A mixed method (QUAL + QUAN) analyses of verbal and written client assessments of the skills yielded converging results

47



Source Sample size


revealing variability in the perceived helpfulness of the skills. The concern regarding being understood by the counsellor (i.e. empathy) was the most important criteria used by the clients to judge the skills. Feeling understood was most enhanced by the skills of restatement and immediacy. The most negatively rated skills were challenge, closed questions, information giving and direct guidance. Recommendations for future research and practice are discussed. Restatement, immediacy, and self-disclosure were the most valued helping skills. Feeling understood yielded higher client ratings. Based upon the four clients we believe that using restatement, immediacy, and self-disclosure could be the most important skills to use. These three skills were most consistently experienced as communicating that the counsellor understood the client.

48



Source Sample size


Our results lead us to hypothesise that European American counsellors working with Mexican and American clients should be especially careful in using challenges, closed questions, information giving and direct guidance in the initial sessions. The same results may occur with other ethnic and racial groups, but caution is recommended. Research with Asian American clients provides a different perspective on client priorities. Agreement between the counsellor and client in the etiology of the client’s problem was found to be an initial priority for Asian American clients (Kim, et al, 2009). Will the same basic skills we found helpful also be perceived positively for Asian American clients in addressing agreement in problem aetiology? Perhaps the European American counsellor needs to communicate with authority; a belief about problem aetiology

49



Source Sample size


that matches the Asian American client rather than first restating the client’s belief. Overall, our results provide hypotheses for future studies and serve to sensitize us to the use of helping skills with other Mexican American clients who are paired in counselling relationships with European American counsellors. While generalizations cannot be made from this exploratory study, it seems noteworthy that these findings may be consistent with Mexican American valuing of confianza, respeto and simpatía. Focus on cross cultural appropriateness and effectiveness of counselling and helping skills.

11 A Narrative and Meta-analytic review of helping skills training: Time to revive a dormant area of enquiry. Clara E. Hill and Robert W. Lent

US Students Helping skills Psychotherapy: Theory, Research, Practice, Training Copyright 2006 by the American Psychological Association

Narrative and meta-analytic review

The authors review previous narrative and meta-analytic reviews on the effectiveness of overall helping skills training programs. The authors then review narrative reviews and conduct a new meta-analysis of

50



Source Sample size


2006, Vol. 43, No. 2, 154–172 0033-3204/06/$12.00 DOI: 10.1037/0033-3204.43.2.154

specific methods used to teach helping skills within these programs. The authors critique the literature and suggest that the studies in the helping skills literature generally fail to meet contemporary methodological standards, thereby limiting the conclusions that can be drawn. The authors appeal for better research on helping skills training, especially as it is currently practiced. programs (e.g., Carkhuff, 1969; Ivey, 1971) were developed to teach discrete helping skills (e.g., reflection of feelings) to beginning therapist trainees, and training was extended to many new populations as well (e.g., peer helpers, parents, teachers, and children). In addition, research on helping skills training was prolific at that time, helping to establish the empirical basis for the training programs (see reviews by Alberts and Edelstein, 1990; Baker and Daniels, 1989; Baker, Daniels,

51



Source Sample size


and Greeley, 1990; Ford, 1979; Kurtz, Marshall, and Banspach, 1985; Matarazzo, 1971, 1978; Matarazzo and Patterson, 1986; Matarazzo, Wiens, and Saslow, 1966; Russell, Crimmings, and Lent, 1984). Helping, individual counselling skills.

12 An Evaluation of Prepracticum Helping Skills Training for Graduate Social Work Students Annemarie Gockel and David L. Burton 2012

US Students Helping skills Annemarie Gockel and David L. Burton (2014) An Evaluation of Prepracticum Helping Skills Training for Graduate Social Work Students, Journal of Social Work Education, 50:1, 101-119, DOI: 10.1080/10437797.2014.856234

132 students qualitative

Although foundational practice classes play a key role in helping pre-practicum students develop counselling skills, we know little about the effectiveness of this form of helping skills training. This study assessed the effect of helping skills training delivered in foundational practice classes on proximal indicators of counselling skills acquisition, including measures of counselling self-efficacy, empathy, anxiety, and hindering self-awareness or rumination. Participating students made significant gains in counselling self-efficacy that were

52



Source Sample size


maintained at three-month follow-up. Reductions in anxiety, rumination, and personal distress in interpersonally challenging situations were observed at follow-up, indicating that students made a successful transition to the field following training. In response to our primary research question, our hypotheses were only partially supported. Students reported significant increases in counselling skills self-efficacy over the course of training but no changes in anxiety, hindering self-awareness, or empathy. Given that counselling self-efficacy is regarded as a key ingredient in counselling skill acquisition and has been empirically related to counselling skill development and counselling performance (Greason and Cashwell, 2009; Larsen and Daniels, 1998). Counselling skills, helping skills.

53



Source Sample size


13 Increase in counselling communication skills after basic and advanced micro skills training. Jeroen Kuntze*, Henk T. van der Molen and Marise P. Born 2009

Netherlands

Students Micro skills 583 Mastering counselling communication skills is one of the requirements that lead to the diploma of a registered European psychologist. The micro counselling method proves to be effective in training these skills. Research into the effectiveness of the micro counselling method often reports overall effect sizes only. The aim of this study was to investigate the adequate use of separate counselling communication skills (seven basic skills: minimal encouragements; asking questions; paraphrasing; reflection of feeling; concreteness; summarizing; and situation clarification and five advanced skills: advanced accurate empathy; confrontation; positive relabelling; examples of one’s own; and directness) Conclusion. The micro counselling method is very effective on the level of separate micro skills. However,

54



Source Sample size


students perform better on the basic skills than on the advanced skills. More training seems to be needed in the latter to achieve the same level of mastery. Counselling skills, micro skills.

14

Lay counselling in humanitarian organisations: a field report on developing training materials for lay counsellors.

BarbaraJuen, Heidi Siller, Michael Lindenthal, Leslie Snider, Marie Nielsen, Marie Louise Mu¡ and NanaWiedemann 2013

Denmark and Austria

All Lay counselling skills

Lay counselling in humanitarian organisations: a field report on developing training materials for lay counsellors

Intervention 2013, Volume 11, Number 1, Page 77 - 88

Field report Systematic Review

Lay counsellors provide valuable

psychosocial support in many

different circumstances, such as

manning telephone helplines for

cancer patients, assisting people

after crisis events or giving

focused support to refugees or

other vulnerable groups. This

paper describes the process that

a consortium of four

humanitarian organisations

followed to develop a training

guide for lay counsellors as it

was found that no common

training curriculum existed. The

process was comprised of the

following steps: 1) review of

existing literature on lay

counselling; 2) a mapping report

to identify organisations and

55



Source Sample size


existing materials available on

trainings for lay counsellors; 3) a

needs assessment to identify the

needs of trainers; 4)

development of drafts of the

training material; 5) pilot

trainings to gain further

understanding of needs and

expectations of participants and

trainers from different

organisational contexts; and 6)

adaptation of the training

materials based on pilot

trainings. The aim of such

support is to promote resilience

in affected individuals, groups

and communities so they may

recover and cope with changing

life circumstances. In terms of

those offering support, lay

counsellors are those who

provide psychosocial support,

but are not clinical, mental

health specialists (i.e. social

workers, psychologists or

psychotherapists). Specially,

they may work on telephone help

56



Source Sample size


lines, crisis intervention, leading

self-help groups, or providing

assistance to the elderly,

children, youth or refugees

through focussed individual

counselling, or practical support.

Many are volunteers, providing

key psychosocial services within

their organisations, and often

work with people facing serious

life challenges. However,

providing lay counsellors with

adequate skills and knowledge to

perform this task is a challenge

in itself, as no common training

curriculum existed. This has

meant that trainers have had to

develop their own training

materials, specific to their own

context, with little or no

awareness of best practice, and

without agreed standards;

alongside support and care for

the lay counsellor’s own

wellbeing.

57



Source Sample size


Therefore, providing quality training is the key to health and wellbeing, of both the beneficiaries and volunteers seeking to support them. Responding to the need for innovative, generic training material, the authors (who represent a variety of humanitarian, care and support organisations) undertook a joint process to develop a standard guide to training lay counsellors, based on enabling a cascade of knowledge and skills transfer within psychosocial support. Focus on a range of roles and settings, skills and qualities of helping role.

58

Appendix 5 – Analysis of codes from SR and GT studies; initial and focused

This table provides an overview of the initial and focused coding from each of the two studies (SR and GT) and the resultant emerging theories or competences.

Initial coding (SR)

Initial coding (GT)

Focused coding (SR)

Focused coding (GT)

Theoretical codes and emerging competences

Empathy Empathic opportunities Empathic attitude Empathic listening Emotional connection Attunement Collaborative Relationship Rapport Sense of agency Autonomy and power balance

a) Outcomes, benefits counselling skill

b) Empathy c) Roles d) Limits and

referral e) Client

centered f) Responding

skills g) Training h) Helper

credibility i) Helping

relationship j) Instrumental

support k) Information

support

Empathy, empathic attitude, attunement Collaborative relationship, sense of agency, trust and power balance

Practical goal focus and advisory role is balanced with empathic and responsive role

Feeling understood,

Benefits of helping, counselling skills Professionalism and ethics Therapeutic conditions The relationship Listening and responding skills Diversity and Empathy

Counselling skills Professional qualities Therapeutic relationship Professional values Role responsiveness Empowerment

59

Initial coding (SR)

Initial coding (GT)

Focused coding (SR)

Focused coding (GT)


Practical goal focus Advisory role balanced with empathic and responsive role Feeling understood Immediacy, here and now Listening, restatement, reframing, naming and attending to distress Physical/practical balanced with psychological (doing and being?) Self-awareness Validation Honesty Patience

l) Emotional support

m) Problematic communication

n) Models and stages of helping

o) Self-awareness p) Feedback q) Listening r) Responsiveness s) Ethics t) Confidentiality u) Professional v) Boundaries w) Diversity x) Common

factors for psychological helping

y) Resilience z) Safety

Za) Instilling hope Zb) Supervision

Focus on the here and now, immediacy, moment by moment Self-awareness

Personal traits

Intercultural references Utilise indirect and non- verbal communication Validate clients experience Work cautiously with emotion Be cautious about using insight

Models and stages of helping work Self-awareness Common factors Supervision

Role specific

60

Initial coding (SR)

Initial coding (GT)

Focused coding (SR)

Focused coding (GT)


Communication at deeper level, communication skills Natural helping ability Personal traits Confidence, knowledge of policies, Self-awareness, reflection, efficacy Active listening, knowledge of trauma, resilience Convey an attitude of non-intrusive support Empowering, supporting, sense of agency Ongoing mentorship Practitioner responsiveness Trust

Respond to client’s implicit communication when they ask for action.

61

Initial coding (SR)

Initial coding (GT)

Focused coding (SR)

Focused coding (GT)


Collaboration, common ground, power imbalance Respect

The table below illustrates how the initial codes were filtered and analysed to produce themes Table 2 Filtering process

Initial coding (SR) a) Outcomes, benefits counselling

skill b) Empathy c) Roles d) Limits and referral e) Client centered f) Responding skills g) Training h) Helper credibility i) Helping relationship j) Instrumental support k) Information support l) Emotional support m) Problematic communication n) Models and stages of helping o) Self-awareness

Initial coding (GT) • Empathy, empathic

opportunities • Empathic attitude, empathic

listening, emotional connection • Attunement • Collaborative relationship,

rapport. • Sense of agency, autonomy and

power balance • Practical goal focus and advisory

role balanced with empathic and responsive role

• Feeling understood • Immediacy, here and now

62

p) Feedback q) Listening r) Responsiveness s) Ethics t) Confidentiality u) Professional v) Boundaries w) Diversity x) Common factors for

psychological helping y) Resilience z) Safety

Za) Instilling hope Zb) Supervision

• Listening, restatement, reframing, naming and attending to distress

• Physical and practical balanced with psychological (doing and being?)

• Self-awareness • Validation • Honesty • Patience • Communication at deeper level,

communication skills • Natural helping ability • Personal traits • Confidence, Knowledge of

Policies, • Self-awareness, reflection,

efficacy • Active listening, knowledge of

trauma, resilience, convey an attitude of non-intrusive support(training)

• Empowering, supporting, sense of agency(training)

• Ongoing mentorship • Practitioner responsiveness • Trust, collaboration, common

ground, power imbalance, respect

Focused coding (SR) Focused coding (GT)

63

Empathy, empathic attitude, attunement. Collaborative relationship, sense of agency, trust and power balance

Practical goal focus and advisory role is balanced with empathic and responsive role

Feeling understood, focus on the here and now, immediacy, moment by moment Self-awareness Personal traits Intercultural references Utilise indirect and non- verbal communication Validate clients experience Work cautiously with emotion Be cautious about using insight Respond to client’s implicit communication when they ask for action.

Benefits of helping, counselling skills Professionalism and ethics Therapeutic conditions The relationship Listening and responding skill Diversity and empathy Models and stages of helping work Self-awareness Common factors Supervision

64


• Counselling skills

• Professional qualities

• Therapeutic relationship

• Professional values

• Role responsiveness

• Role specific

• Empowerment

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Glossary Analysis Detailed examination of the elements or structure of something. Attending Responding to verbal and non-verbal cues with understanding and insight. Autonomy The right or condition of self-government. The capacity to make an informed, uncoerced decision. Benchmark A standard or point of reference against which things may be compared. Bias Inclination or prejudice for or against something, especially if it is considered unfair. Blocks to listening Things that get in the way of really listening and hearing someone. There are external blocks to listening – noisy surroundings, accents or language barriers, distractions. There are also internal blocks to listening – personal thoughts, feelings, and opinions, physical health and comfort etc. Boundaries Offer safe limits to each encounter with someone. Boundaries provide a framework to work from. They set the structure for the relationship and working alliance. GT Constructivist grounded theory. A systematic methodology in the social sciences involving the construction of theories through methodical gathering and analysis of data. The theory is literally grounded in the actual data. Challenge Also known as confrontation, means to gently bring a discrepancy to someone to raise their awareness. It could be noticing someone smiling or laughing when they talk about something very sad. Clinical skills A discrete and observable act within the overall process of patient care. Coding An analytical process in which data are categorised to facilitate analysis. Collaboratively Working together.

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Constant comparative method An inductive data coding process used for categorising and comparing qualitative data for analysis purposes. Counselling skills Can also sometimes be called helping skills, active listening skills. Counselling skills are a combination of values, ethics, knowledge and communication skills that are used to support another person’s emotional health and wellbeing. They are not exclusive to counsellors since a wide range of people use them, often to enhance a primary role. Their use is therefore dependent on who is using them and the setting in which they’re used. Counselling A talking therapy that is delivered by a trained practitioner, who works with people either short or long term to help them bring about effective change and enhanced wellbeing. Competence and competence framework A cluster of knowledge, skills, abilities, behaviours and attitudes related to job success and failure. Therefore, a competency framework is something that broadly defines the knowledge and skills needed to be effective within a role or sector. Confidentiality Keeping something private or secret. Not disclosing to others. Confidentiality limits When working with others, not everything can be kept private and confidential. There are legal limits where confidentiality must be broken e.g. terrorism, money laundering, drug trafficking. Confidentiality may be broken where there is a serious risk of harm too. Culture The ideas, customs and social behaviour of a particular people or society. Data protection Legal control over access to and use of data stored in computers. Data saturation The point in the research process where the data search and analysis offer no new information and can therefore cease. Data synthesis To combine research findings and results from different studies to provide a clear answer and a single summary. Diversity Variety. A range of different things or people. Understanding that each individual is unique with a unique set of characteristics.


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Eligibility criteria Guidelines for what can or cannot be included in a research study. Emerging themes These are identified in the first stages of analysis. Concepts in the data with closely linked meanings are assigned codes. Codes with similar meanings are brought together and become emerging themes. Empathy and empathic understanding The ability to understand the feelings of another. To understand feelings, thoughts and experiences from someone else’s perspective. Equalities Act A law which protects people from discrimination. It means that discrimination or unfair treatment on the basis of certain personal characteristics is against the law. ERG expert reference group A group of experts in a particular field who form a time limited task and finish group. They generally refine the scope of the work and make recommendations to inform the research tasks. Ethics Principles that govern a person or group of people. A moral philosophy: .g. BACP’s Ethical Framework for the Counselling Professions. Focusing Helps someone to direct their conversational flow into what is most important for them. Enables them to get in touch with the emotions behind the story or narrative. It is a little like zooming in on a photograph and seeing a close-up of a particular place, thing or relationship. Frame of reference A particular set of ideas and beliefs upon which someone makes judgments about themself and the world. GDPR General Data Protection Regulation A regulation in EU law on data protection and privacy for all people. Helping skills See counselling skills. Immediacy This is the ability to use what is happening in the present to look at what is happening in the relationship with the person you are working with and supporting. Immediacy can be quite challenging as it invites an intimate exploration in the moment. Information analyst Responsible for creating reports, researching and analysing data.


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Interpersonal skills The ability to communicate or interact well with other people. Inter-rater-reliability testing This method assesses the external consistency of a test. This refers to the degree to which raters (experts) give consistent feedback on a particular issue. If their feedback is similar, then the data are reliable. Kindness A personal quality that enhances working with others. It is the quality of being considerate, generous, nice and caring towards self and others. Lay counselling Lay counsellors provide a supportive service that complements the work provided by other trained professionals. They generally provide emotional support but are not qualified counsellors. Limits of ability Something that controls what someone is able to do. They are determined by levels of training, experience and competence in a given area which dictate who and what someone is safely able to work with. Listening and responding skills Key counselling skills. Listening is a process of selecting, attending to, creating meaning from, remembering and responding to someone’s verbal and non-verbal messages: responding skills are communication skills that show interest and understanding in what someone is communicating by careful focusing and listening techniques. Literature search A systematic, thorough search of all types of literature in a given subject (e.g. research papers, books, articles) Methodology The systematic theoretical analysis of the methods applied to a field of study. Minimal encouragers Subtle, non-verbal and short verbal actions that encourage someone to continue talking and tell more. They include, nods, shrugs, deep breaths and mmms etc. Motivation Willingness and desire to do something. Creates action. Non-verbal communication Relating to someone without the use of language. T is the transmission of information through, visual, auditory, tactile and kinaesthetic channels. These include eye contact, gestures, body movements, posture and facial expressions. Non-verbal communication tends to convey more meaning than verbal communication.


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Paraphrasing Repeating back to someone your understanding of what they have said. It reflects the essence of what someone has said using different words. It lets someone know they are being carefully listened to and understood. Peer counselling A helping process that involves one-to-one support between members of a group, with a common purpose. Peer reviewer Someone with knowledge and experience in a particular field who offers feedback on a piece of work or research in that particular subject area. Personal qualities Personal attributes helpful to support others with include, kindness and care, compassion and consideration, integrity, patience and tolerance, and emotional maturity. Person-centred A person-centred approach focuses on an individual’s personal needs, wants, desires and goals so that they are central to the care and support they need. Prejudice An unfair and unreasonable opinion or feeling, usually formed without thought or knowledge. An unreasonable dislike of a particular group of people or things. Primary role The main role into which counselling skills are embedded e.g. nurse, carer, paramedic, support worker, or social worker. Privacy notice A statement that describes how someone’s personal information is collected, used, retained and disclosed. Professional context A set of dynamic relationships between the people, setting, issue, technologies and documents of a particular role. Purposive data sample A non-probability sample that is selected based on characteristics of a population and the objectives of the study. It relies on the judgment of the researcher. PSDF Professional standards development facilitator, person responsible for the facilitation of the counselling skills project and a member of o professional standards department.


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Psychosocial support The provision of psychological and social resources to a person by a supporter intended for the benefit of the receiver’s ability to cope with problems faced. Qualification An ability, characteristic, or experience that makes you suitable for a particular job or activity. Most learning and training experiences result in a qualification. Qualitative research A scientific method of observation to gather non-numerical data. This type of research refers to the meanings, concepts, definitions, characteristics, metaphors, symbols and descriptions of things and not to their counts or measures. Quantitative The systematic empirical investigation of observable phenomena via statistical, mathematical, or computational techniques. Quality assurance The maintenance of a desired level of quality in a service or product, especially by means of attention to every stage of the process of delivery or production. Questions (use of) There are several types of questions; some are more useful than others and some questions are not helpful at all. The two main types of questions are open and closed. Open questions invite someone to say more about a topic. E.g. how did you feel when your mum wouldn’t open the door? Closed questions are fact-finding questions, they generally require a yes or no answer and close a conversation down. E.g. are you female? Rapport A close, harmonious relationship in which the people involved feel connected safely and warmly. Referral The act of directing someone to a different person or place for further or more appropriate help, support and information. Reflecting Reflecting feelings is determining the feelings and emotions in a person’s verbal and non-verbal communication and stating them back to the person. A reflective listener focuses on the feelings in someone’s story, rather than the facts. Reframing Supporting someone to see a person, situation or thing differently by changing its meaning. It can help by offering a slightly different perspective.


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Research The systematic investigation into and study of materials and sources in order to establish facts and reach new conclusions. Resilience The ability to mentally or emotionally cope with a crisis or to return to pre-crisis status quickly. The capacity to recover from difficulties. Toughness. Responsiveness Timely and helpful responses that acknowledge and meets someone’s wants and needs. The quality of responding quickly and positively. Restating Repeating back to someone word for word what they just said. Usually brief one-two words. Risk assessment A systematic process of evaluating the potential risks present. Safeguarding Measures to protect the health, wellbeing and human rights of individuals, which allow people - especially children and vulnerable adults – to live free from abuse, harm and neglect. Self-awareness Conscious knowledge of one’s own character and feelings. Self-care The practice of taking action to preserve or improve one’s own health. Protecting one’s own wellbeing and happiness. Self-disclosure When someone shares their personal experience, feelings, situation with someone in order to help or support them. Silence (use of) Encourages someone to explore further and reflect on their feelings and situation on a deeper level. It can be difficult to use the skill of silence and ensure there is not too much or too little. Stereotype A widely held but fixed and oversimplified image or idea about a particular category of people. Generalisations that prejudge who someone is based on certain characteristics e.g. race, gender, sexuality.


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Summarising Bringing together all the threads of an interaction into a single statement that covers the content of what has been said; especially useful at the end of a period of time with someone. It condenses the main points of a conversation, giving someone the opportunity to listen and recap. Supervision and supervisory support Showing and giving support to someone to help them progress in their work and feel valued and comfortable. It develops good practice in the workplace, builds skills, knowledge and a collegiate relationship. The person offering supervision, generally has more knowledge and experience than the person they are supporting. Systematic Review A type of literature review that uses systematic methods to collect and critically appraise data, followed by synthesising findings quantitatively or qualitatively. The findings are designed to provide a whole picture of a given subject or question through existing evidence. Unhelpful responses Responses that hinder rather than support someone’s wellbeing e.g. interrupting and talking over, giving advice and telling someone what to do, overuse of questions, rescuing etc. Working alliance The relationship formed when working with or supporting someone. It is important to develop an affective bond and to set out the boundaries and limits of the relationship as well as establishing the tasks and goals of the work.

counselling skills competence framework research methodology · and pilling (2008) methodology,...

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